U.S. patent application number 14/767209 was filed with the patent office on 2016-01-07 for trocar.
The applicant listed for this patent is Pajunk GmbH Medizintechnologie. Invention is credited to Heinrich PAJUNK, Horst PAJUNK.
Application Number | 20160000462 14/767209 |
Document ID | / |
Family ID | 50073187 |
Filed Date | 2016-01-07 |
United States Patent
Application |
20160000462 |
Kind Code |
A1 |
PAJUNK; Horst ; et
al. |
January 7, 2016 |
Trocar
Abstract
A trocar with a trocar sleeve, comprising a valve device
arranged at the proximal end of the trocar sleeve and comprising a
trocar pin which can be inserted axially into the trocar sleeve
through the valve device and which has a hollow shaft and a
tapering transparent distal tip. An endoscopic optical unit, such
that the adjacent body tissue can be observed through the distal
tip, can be introduced into the hollow shaft of the trocar pin, and
a proximal insufflation connection allows a gas to be introduced
into the trocar sleeve.
Inventors: |
PAJUNK; Horst; (Geisingen,
DE) ; PAJUNK; Heinrich; (Geisingen, DE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Pajunk GmbH Medizintechnologie |
Geisingen |
|
DE |
|
|
Family ID: |
50073187 |
Appl. No.: |
14/767209 |
Filed: |
February 11, 2014 |
PCT Filed: |
February 11, 2014 |
PCT NO: |
PCT/EP2014/052597 |
371 Date: |
August 11, 2015 |
Current U.S.
Class: |
604/26 |
Current CPC
Class: |
A61B 2017/00907
20130101; A61B 17/3421 20130101; A61M 13/00 20130101; A61B 17/3498
20130101; A61B 2017/3454 20130101; A61B 90/37 20160201; A61B
17/3417 20130101; A61B 17/3474 20130101 |
International
Class: |
A61B 17/34 20060101
A61B017/34; A61M 13/00 20060101 A61M013/00 |
Foreign Application Data
Date |
Code |
Application Number |
Feb 11, 2013 |
DE |
10 2013 101 336.8 |
Claims
1. A trocar, comprising: a cannula; a valve device arranged at the
proximal end of the cannula; and an obturator that can be inserted
axially into the cannula through the valve device, which obturator
has a hollow shaft and a transparent tapered distal tip, into which
hollow shaft of the obturator an endoscope optical system can be
inserted such that the contacting body tissue can be observed
through the distal tip, a proximal insufflation connection making
it possible to introduce a gas into the cannula, the distal end of
the cannula lying against the outer circumference of a cylindrical
end segment of the obturator if the obturator is inserted into the
cannula, which cylindrical end segment proximally adjoins the
tapered tip, and the gas introduced through the insufflation
connection being able to enter an annular space between the outer
wall of the obturator and the inner wall of the cannula and to
escape via a distal gas outlet if the obturator is inserted,
wherein the distal gas outlet is formed by at least one
gas-conducting channel, which extends in the jacket of the
cylindrical end segment in the longitudinal direction of the
obturator and extends axially at least over the length over which
the distal end of the cannula lies against the cylindrical end
segment of the inserted obturator.
2. The trocar according to claim 1, wherein the at least one
gas-conducting channel extends distally beyond the cylindrical end
segment into the jacket of the tapered distal tip.
3. The trocar according to claim 2, wherein the at least one
gas-conducting channel is led to the distal end of the tip.
4. The trocar according to claim 1, wherein at least two
gas-conducting channels are provided, which are arranged
diametrically to each other.
5. The trocar according to claim 1, wherein the at least one
gas-conducting channel is formed by at least one gas-conducting
groove, which extends as a recessed furrow in the outer lateral
surface of the cylindrical end segment and possibly of the tapered
distal tip.
6. The trocar according to claim 1, wherein the at least one
gas-conducting channel is formed by a gas-conducting pipe, which
extends in the wall of the jacket of the cylindrical end segment
and possibly of the tapered distal tip.
7. The trocar according to claim 1, wherein the tapered distal tip
substantially has the shape of a cone having two flat areas which
are mirror-symmetric with respect to the axial center plane.
8. The trocar according claim 2, wherein the gas-conducting grooves
extend in the flat areas.
9. The trocar according to claim 1, wherein the tapered distal tip
and the cylindrical end segment adjoining the tapered distal tip
form an injection-molded part composed of a transparent
plastic.
10. The trocar according to claim 7, wherein the endoscope optical
system has a distal end surface slanted toward the center axis, the
edge of which distal end surface lying furthest in the distal
direction engages in the peripheral region of the distal tip having
the conical lateral surface between the flat areas when the
endoscope optical system is inserted into the obturator.
11. The trocar according to claim 10, wherein the endoscope optical
system has a distal end surface slanted at 30.degree..
Description
[0001] The invention relates to a trocar according to the preamble
of claim 1.
[0002] Trocars are used in medicine, particularly in minimally
invasive surgery, in order to create a point of access into the
body of a patient, e.g., into the abdominal cavity of the patient.
The trocar consists of a cannula and an obturator that can be
axially inserted into said cannula. The obturator is also referred
to as a trocar mandrel. Sometimes, the obturator alone is also
referred to as a trocar.
[0003] A valve device is arranged at the proximal end of the
cannula. The valve device is used to seal in an air-tight manner
the obturator inserted into the cannula or instruments and the like
inserted through the cannula. Furthermore, the valve device is used
to close the cannula in an air-tight manner when no obturator,
instrument, or optical system is inserted. If the obturator is
inserted into the cannula, the distal end of the obturator
protrudes distally from the cannula. Said distal end of the
obturator is designed as a tapered tip, which is used to penetrate
and/or dilate the body tissue during the insertion of the
trocar.
[0004] In order to reduce the risk of injuries to internal organs
during the insertion of the trocar by means of the tip of the
obturator, so-called optical trocars are used. In the case of these
optical trocars, the obturator has a hollow shaft and at least the
tapered distal tip is transparent, see-through, or at least
translucent. An endoscope optical system can be inserted into the
obturator, by means of which endoscope optical system the tissue
lying against the outside of the tip and thus the penetration of
the trocar tip can be observed through the transparent tip.
[0005] The cannula has an insufflation connection at the proximal
end of the cannula. If the cannula is inserted into the abdominal
wall and the obturator is pulled out of the cannula, gas can be
introduced into the abdominal cavity via the insufflation
connection and the cannula in order to raise the abdominal wall and
expand the intracorporeal operating field. Because the insufflation
cannot occur until the trocar has been inserted at least to such an
extent that the distal end of the cannula is completely pushed
through the abdominal wall, there remains a residual risk of injury
to organs or vessels adhering to the abdominal wall even when an
optical trocar is used. Therefore, an insufflation of the abdominal
cavity preferably is performed by means of a so-called Veress
needle before the first insertion of a trocar.
[0006] A trocar of the type mentioned at the beginning that enables
insufflation through the trocar even during the first insertion of
the trocar, even before the distal end of the cannula has
completely penetrated the abdominal wall, is known from US
2010/0081988 A1. For this purpose, the hollow shaft of the
obturator has wall bores, and gas outlet openings are provided in
the distal tapered tip of the obturator. Via the proximal
insufflation connection, gas is introduced into the annular space
between the outer wall of the obturator and the inner wall of the
cannula. Said gas enters the interior of the hollow shaft through
the wall bores and can flow along the periphery of the endoscope
optical system to the distal tip of the obturator, where the gas
can escape through the outlet openings. The tip of the obturator is
inserted through the abdominal wall under visual observation by
means of the endoscope optical system. As soon as the distal tip
having the gas outlet opening enters the abdominal cavity, a first
insufflation can be performed via said gas outlet opening, by means
of which first insufflation the abdominal wall is distanced from
internal organs so that the trocar can be inserted further with
minimal risk until the cannula reaches its position.
[0007] The problem addressed by the invention is that of creating a
trocar of the type mentioned at the beginning that ties a simpler
design.
[0008] According to the invention, said problem is solved by means
of a trocar having the features of claim 1.
[0009] Advantageous embodiments of the invention are specified in
the dependent claims.
[0010] The trocar according to the invention enables insufflation
during the first insertion as soon as the distal tip of the
obturator penetrates the abdominal wall and enters the abdominal
cavity. For this purpose, gas is introduced into the cannula via
the proximal insufflation connection. The gas flows in the annular
space between the outer wall of the obturator and the inner wall of
the cannula to the distal end of the cannula. There, the gas can
escape through at least one gas-conducting channel, which extends
in the jacket of a distal cylindrical end segment of the obturator
in the longitudinal direction. Said at least one gas-conducting
channel thus tunnels under the distal end of the cannula, which
otherwise lies tightly against said cylindrical end segment. As
soon as the trocar has penetrated the abdominal wall by means of
the transparent distal tip of the obturator under visual
observation, gas can be insufflated into the abdominal cavity via
the gas-conducting channels before trocar completely enters the
abdominal cavity.
[0011] The at least one gas-conducting channel must extend in the
axial direction at least over the length over which the distal end
of the cannula lies against the cylindrical end segment of the
inserted obturator. The at least one gas-conducting channel
preferably additionally extends further in the distal direction
beyond said cylindrical end segment into the distally tapered tip.
Thus, a first insufflation via the gas-conducting channels becomes
possible as soon as the distal end of the tip has entered the
abdominal cavity, i.e., still before the tapered tip has completely
entered and the insertion hole has expanded to the diameter of the
cylindrical end segment or the diameter of the cannula.
[0012] In an advantageous embodiment, the at least one
gas-conducting channel is designed as a gas-conducting groove,
which extends in the outer lateral surface-of the distal end part.
The gas-conducting groove is designed as an outwardly open recessed
furrow in the outer lateral surface. This embodiment offers the
advantage of simple production. In another embodiment, the at least
one gas-conducting channel is designed as a pipe, which extends
inside the wall of the jacket of the distal end part. The pipe is
closed over its entire circumference and has an inlet opening and
an outlet opening only at the ends of the pipe. The pipe-shaped
design of the gas-conducting channel has the advantage that the
cross-section of the gas-conducting channel cannot be obstructed.
However, a greater wall thickness of the jacket is required and the
production of the pipe-shaped gas-conducting channels is more
complex.
[0013] In a preferred embodiment, the distal tip tapered in the
distal direction substantially has the shape of a cone, which has
two flat areas of the lateral cone surface, which flat areas are
mirror-symmetric with respect to the axial center plane. This shape
of the tip makes the penetration of the tissue easier. If
gas-conducting grooves are led to the distal end of the tip, these
gas-conducting grooves are preferably arranged in the flat areas.
During the penetration of the tip into the body tissue, the tissue
lies against these flat areas with a pressure that is smaller than
the pressure with which the tissue lies against the conical lateral
regions of the tip. Therefore, there is a lesser tendency of the
tissue to penetrate into the recessed gas-conducting grooves and to
block the recessed gas-conducting grooves.
[0014] In the case of optical trocars, an endoscope optical system
whose distal end surface is slanted toward the center axis of the
endoscope optical system or of the obturator is often used. In
particular, so-called 30.degree. optical systems are common, in the
case of which the distal end surface is slanted toward the center
axis at an angle of 30.degree.. If an endoscope optical system
having a slanted distal end surface is used, the least image
distortion results if the distal end surface of the endoscope
optical system inserted in the obturator is directed toward the
conical non-flattened lateral region of the tapered transparent
tip. This optimal orientation is preferably positively effected in
that the edge region of the distal end surface lying furthest in
the distal direction engages in this conical peripheral region of
the tip, because a circular-arc-shaped free peripheral angle is
available there for the insertion of the endoscope optical system.
If the endoscope optical system is inserted into the obturator, the
endoscope optical system orients itself in the optimal angular
position positively or possibly by means of slight rotational
motions.
[0015] Additional features and advantages of the invention result
from the following description of an embodiment example shown in
the drawing.
[0016] FIG. 1 shows a side view of the complete trocar.
[0017] FIG. 2 shows a perspective view of said trocar.
[0018] FIG. 3 shows an enlarged illustration of the distal tip of
the trocar according to image detail X in FIG. 2.
[0019] FIG. 4 shows a perspective view of the cannula.
[0020] FIG. 5 shows an axial section through the cannula.
[0021] FIG. 7 shows a partially axially cut side view of the
obturator.
[0022] FIG. 8 shows the distal end part of the obturator.
[0023] FIG. 9 shows an axial top view of the distal end part.
[0024] FIG. 10 shows an axial section of the distal end part
according to section line A-A in FIG. 9.
[0025] FIG. 11 shows an axial section of the distal end part
according to section line B-B in FIG. 9.
[0026] FIG. 12 shows an axial partial section of the distal end of
the cannula.
[0027] FIG. 13 shows a side view of the obturator with the
endoscope optical system inserted.
[0028] FIG. 14 shows the distal end of the obturator with the
endoscope optical unit inserted in perspective view.
[0029] FIG. 15 shows an axial section, corresponding to FIG. 10, of
the distal end part in another embodiment.
[0030] In FIGS. 1 and 2, a trocar according to the invention is
shown which has a cannula 10, into which an obturator 30 can be
axially inserted. The cannula 10 is shown in detail in FIGS. 4 and
5, while the obturator 30 is shown and explained in detail in FIGS.
6 to 11.
[0031] The cannula 10 consists of a cannula tube 11, which is
produced, for example, from a transparent plastic. A valve device
12 is arranged at the proximal end of the cannula tube 11. The
valve device 12 has a passage axially aligned with the cannula tube
11, through which passage the obturator 30 or instruments or
optical systems can be inserted into the cannula tube 11. The
passage of the valve device is provided with a seal, which closes
the passage and thus the cannula tube 11 in an air-tight manner if
no obturator or instrument is inserted through the valve device. If
an obturator, an instrument, an optical system, or the like is
inserted through the valve device, a second seal lies against the
periphery of the obturator, of the instrument, or of the optical
system in a sealing manner. Distally before the seals, an
insufflation connection 14 leads radially into the passage of the
valve device 12 and thus to the inner lumen of the cannula tube 11.
The insufflation connection 14 can be closed by means of a tap 15.
In this respect, the cannula 10 together with the valve device 12
is designed in a manner known per se.
[0032] The obturator 30 shown in FIGS. 6 and 7 has a tubular hollow
shaft 31, which is preferably produced from stainless steel. A
knurled knob 32, which is used to handle the obturator 30, is
arranged at the proximal end of the shaft 31. A distal end part 33
is coaxially inserted into the distal end of the shaft 31 and
preferably adhesively bonded to the shaft 31, as can be seen in
FIG. 7.
[0033] The distal end part 33, which is shown as an individual part
in FIGS. 8 to 11, is preferably produced as an injection-molded
part and is composed of a transparent, preferably see-through
crystal-clear plastic. The distal end part 33 has a straight,
circular cylindrical end segment 34, which is coaxially inserted
into the distal end of the shaft 31 by means of an attachment
segment 35 and is adhesively bonded to the shaft 31. The outside
diameter of the end segment 34 corresponds to the outside diameter
of the shaft 31, so that the circumferential lateral surfaces of
the shaft 31 and of the end segment 34 adjoin each other without a
step. The distal end part 33 having a distal tip 36 tapered in the
distal direction distally adjoins the end segment. 34. The distal
tip 36 substantially has the shape of a cone, i.e., a right
circular cone. The conical lateral surface 37 of the tip 36 is
flattened on two diametrically opposite sides, so that two flat
areas 38 which are mirror-symmetric with respect to a central axial
plane of the end part 33 are formed, which flat areas 38 extend
from the end segment 34 to the distal end of the tip. The flat
areas 38 are preferably drawn inward slightly, as can be seen.
particularly in FIG. 10. The distal end of the tip 36 is designed
as a flat runner 39, which protrudes slightly beyond the flat areas
38 in the distal direction and is rotated toward the plane of
symmetry of the two flat areas 38 at an angle about the center axis
of the end part 33, as can be seen most clearly in FIG. 9. The
runner 39 approximately has the shape of the working tip of a
flat-head screwdriver.
[0034] At least one gas-conducting channel is formed in the jacket
of the distal end part 33. The at least one gas-conducting channel
has the shape of a gas-conducting groove 40 extending in the outer
lateral surface of the distal end part 33. In the embodiment
example shown, four gas-conducting grooves 40 are provided. The
gas-conducting grooves 40 are designed as recessed furrows in the
outer lateral surface. The cross-sectional shape and depth of the
gas-conducting grooves 40 can be freely selected in a wide range.
The gas-conducting grooves 40 have a triangular or semicircular
cross-sectional profile, for example, and a depth of approximately
0.25 mm, for example. The gas-conducting grooves 40 extend in the
longitudinal direction of the end part 33 and extend axially,
starting from the attachment segment 35, over the entire length of
the end segment 34 and extend over the distal tip 35 to the distal
end of the distal tip 36, as can be seen best in FIG. 8. In the
present embodiment example, pairs of two gas-conducting grooves 40
are arranged diametrically to each other. The two gas-conducting
grooves 40 of each pair extend parallel to each other and are
arranged in the peripheral angle of the end part 33 in such a way
that she pairs of the gas-conducting grooves 40 each extend within
the flat areas 38 to the distal end of the tip 36. This can be seen
most clearly in FIGS. 8 and 9.
[0035] The distal end 16 of the cannula tube 11 of the cannula 10
is shown in a partial section in FIG. 12. This distal end 16 can
preferably be slanted with respect to the center axis of the
cannula tube 11, as FIGS. 4 and 5 show. The slant is, for example,
30.degree.. The distal end 16 has an inner edge 17, the clear
inside diameter of which corresponds to the outside diameter of the
end segment 34 of the end part 33 of the obturator 30. Adjacently
to this inner edge 17 in the proximal direction, the clear inside
diameter of the cannula tube 10 expands in a region 18 to the
somewhat larger clear inside diameter of the cannula tube 11. The
clear inside diameter of the cannula tube 11 is, for example, 0.5
mm greater than the clear inside diameter of the inner edge 17.
[0036] For the use of the trocar, the obturator 30 is inserted from
the proximal end through the valve device 12 into the cannula 10,
until the knob 32 stops against the valve device 12. The distal tip
36 of the distal end part 33 then protrudes distally from the
distal end 16 of the cannula tube 11, as is shown in FIGS. 1 to 3.
At the proximal end, the obturator 30 is sealed in the valve device
12. The cannula tube 11 lies tightly against the outer
circumference of the cylindrical end segment 34 of the distal end
part 33 of the obturator 30 by means of the inner edge 17. Because
the inside diameter of the cannula tube 11 is somewhat greater than
then clear inside diameter of the inner edge 17, an annular space
remains free between the outer wall of the shaft 31 of the
obturator 30 and the inner wall of the cannula tube 11. The
insufflation connection 14 of the valve device 12 leads into the
passage of the valve device 12 and thus into this annular space
between the shaft 31 of the obturator 30 and the inner wall of the
cannula tube 11. This annular space is distally sealed by the inner
edge 17, which lies against the circumference of the end segment
34. However, the gas-conducting grooves 40 in the end segment 34 of
the distal end part 33 tunnel under the sealing of the inner edge
17, so that the gas-conducting grooves 40 form a connection between
said annular space and the surroundings of the distal tip 36. If a
gas or another fluid is introduced through the insufflation
connection 14, said gas can enter the annular space between the
cannula tube 11 and the obturator 30 via the insufflation
connection 14 and can escape from the cannula tube 11 distally via
the gas-conducting grooves 40.
[0037] In order to be able to insert the trocar under visual
observation, an endoscope optical system 50 is inserted through the
knob 32 into the obturator 30, as FIG. 13 shows. The obturator 30
is inserted into the cannula 10, as is shown in FIGS. 1 and 2. The
trocar is then inserted into the abdominal wall through a skin
incision, wherein the distal tip 36 of the obturator 30, together
with the runner 39, causes a perforation of the tissue and a
dilation of the perforation opening. Because the distal end part 33
is see-through, the body tissue in front of the distal tip 36 and
the body tissue lying laterally against the distal tip 36 can be
observed by means of the endoscope optical system 50. Likewise, the
manner in which the tip 36 penetrates the body tissue can be
observed. As soon as the distal end of the tip 36 has penetrated
the abdominal wall and entered the abdominal cavity, gas can be
insufflated into the abdominal cavity via the insufflation
connection, the annular space within the cannula tube 11, and the
gas-conducting grooves 40. The abdominal wall can thereby be
distanced from internal organs of the abdominal cavity so that the
further advance of the distal tip 36 into the abdominal cavity can
be continued without the risk of an injury to internal organs.
Because the gas-conducting grooves 40 extend within the flat areas
38 in the region of the tapered distal tip 36, the pressure of the
body tissue lying against the tip 36 is absorbed substantially by
the conical lateral surfaces 37 of the tip 36 and the body tissue
is not pressed into the gas-conducting grooves 40, so that the
gas-conducting grooves 40 remain free for the passage of gas.
[0038] An endoscope optical system known per se can be used as the
endoscope optical system 50. Such an endoscope optical system 50 is
often designed with a slanted distal end surface 51. In the case of
so-called 30.degree. optical systems, the distal end surface 51 is
slanted at an angle of 30.degree. toward the center axis of the
endoscope optical system 50, as is shown in the embodiment example
in FIGS. 13 and 14. The main viewing direction of such an endoscope
optical system 50 extends perpendicularly to the end surface 51 and
thus is angled at an angle of, e.g., 30.degree. with respect to the
center axis of the endoscope optical system 50 and of the obturator
30. In order to obtain an image of the body tissue at the distal
tip 36 that is distorted as little as possible, it is advantageous
if the endoscope optical system 50 views through a region of the
distal tip 36 that is designed as a conical lateral surface 37 and
that is located between the flat areas 38 in the peripheral
direction. According to the invention, an endoscope optical system
50 having an end surface 51 slanted at, for example, 30.degree. is
positively oriented in this optimal viewing direction. This is
effected in that the peripheral region of the end surface 51 lying
furthest in the distal direction can be axially advanced further
into the distal tip 36 in the distal direction if said peripheral
segment lying furthest in the distal direction is located in the
region of a conical lateral surface 37, as is shown in FIG. 14. In
FIG. 14, the distal end of the tip 36 is cut off in order to make
the orientation of the end surface 51 of the endoscope optical
system 50 clearly visible. By slightly rotating the endoscope
optical system 50 during the insertion, the optimal angular
orientation of the end surface 51 within the distal tip 36 results.
If the distal end surface 51 has entered this one conical surface
lateral surface 37 of the distal tip 36 of the obturator 30, the
viewing direction of the end surface 51 is directed toward the
diametrically opposite conical lateral surface 37, which delivers
the optical image with the least distortion.
[0039] In a further embodiment shown in FIG. 15, the at least one
gas-conducting channel is designed as a gas-conducting pipe 42. In
the embodiment example shown, two gas-conducting pipes 42 arranged
diametrically to each other are provided. The gas-conducting pipes
are designed as pipes which are completely embedded in the wall of
the end part 33 and which are closed over their entire
circumference. The gas-conducting pipe 42 has an inlet opening 43
only at the proximal end of the cylindrical end segment 34 and a
distal outlet opening 44. The at least one gas-conducting pipe 42
extends axially at least over the length of the cylindrical end
segment 34, against which the distal end 16 of the cannula 10 lies.
The at least one gas-conducting pipe 42 preferably extends distally
beyond the cylindrical end segment 34 into the distal tip 36 so
that the outlet openings 44 lie at the front distal end of said tip
36.
[0040] In this second embodiment, the distal end part 33 is
preferably produced from plastic in axially separate partial
shells, wherein the gas-conducting pipes 42 are designed as furrows
in the abutting surfaces by means of which the partial shells are
joined.
[0041] The use of the trocar having the distal end part 33 of the
obturator 30 in this second embodiment corresponds completely to
the previously described use in the first embodiment.
LIST OF REFERENCE SIGNS
[0042] 10 Cannula
[0043] 11 Cannula tube
[0044] 12 Valve device
[0045] 14 insufflation connection
[0046] 15 Tap
[0047] 16 Distal end
[0048] 17 Inner edge
[0049] 18 Region
[0050] 30 Obturator
[0051] 31 Shaft
[0052] 32 Knob
[0053] 33 Distal end part
[0054] 34 End segment
[0055] 35 Attachment segment
[0056] 36 Distal tip
[0057] 37 Conical lateral surface
[0058] 38 Flat areas
[0059] 39 Runner
[0060] 40 Gas-conducting groove
[0061] 42 Gas-conducting pipe
[0062] 43 Inlet opening
[0063] 44 Outlet opening
[0064] 50 Endoscope optical system
[0065] 51 End surface
* * * * *